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Digital Transformation in Nursing and Geriatric Care Faces Many Challenges

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Krems (Austria), 17. August 2022 – Nursing care is being digitized at a rapid pace, but many ethical questions about it remain unanswered. Initial answers were provided by an international symposium at which experts exchanged views across disciplines and sectors. The recently published results deal with historical and ethical aspects of digitalization in nursing as well as the impact on training. In particular, the areas of inpatient care, assistance systems and robotics are examined in more detail. The symposium and the subsequent publication of the proceedings were coordinated by researchers from the Karl Landsteiner University of Health Sciences and the Ruprecht-Karls-Universität Heidelberg.

The digitalization of care ranges from digital documentation to smart homes to socially acting robots. Driven by technological innovations and demographic developments, it is increasingly changing the way nursing is carried out; an activity that was previously strongly characterized by interpersonal relationships. The resulting ethical challenges are complex and multifaceted. Mastering them requires expertise from fields as diverse as nursing science, medical informatics, engineering, medicine, IT, and the social sciences and humanities. For the first time in the German-speaking world, a symposium supported by the Volkswagen Foundation created the opportunity for an exchange between these disciplines.

“Digitalization is seen as an important tool for person-centered care,” says Prof. Giovanni Rubeis, head of the Department of Biomedical Ethics and Health Care Ethics at Karl Landsteiner University of Health Sciences (KL Krems) and co-editor of the symposium volume. “This technologization is changing care quite fundamentally, and at the symposium we discussed the ethical aspects from different perspectives.” For example, a look at history showed that during the earlier introduction of technical assistance systems – such as monitors – there were parallels to the current critical attitude toward the introduction of artificial intelligence. At the same time, such systems strengthen(ed) nursing competence then as now, thus enhancing this profession amongst medical peers.

In the symposium volume, the experts also discuss the narrowing of the concept of nursing through increasingly comprehensive digital documentation. They do not deny that digital documentation could improve the quality of care and provide nurses with legal security. To this end, initial practical experiences with the use of web platforms and apps are also discussed, with particular attention paid to the acceptance of such tools by caregivers.

One particularly exciting aspect of the symposium was the question of whether digitalization is viewed too much from the perspective of making work easier and too little from that of supporting care. In any case, the consensus is that digital professionalism urgently needs to become a fixed component of university education. Not least because young students are showing enormous interest in this training. The use of so-called serious games (infotainment games) was also discussed in this context.

The participants also see ethical challenges in the use of assistance systems in old age; in particular, systems that are intended to record specific activities of older persons (movement, falls, sleep, etc.). Here, it must be ensured that these systems accept individual behavior patterns of single persons and do not lead to disciplining behavior norms. The consensus is that the self-determination of the elderly must be preserved.

Robots are also discussed critically and constructively. In the field of care, robots are no longer simple tools, but complex technical counterparts that enter into social relationships with the person in need of care. In the process, mock elements such as human-like appearance or speech are used. This raises questions about the social as well as normative status to be accorded to these manifestations.

With the publication of the conference proceedings, a multi-perspective discourse on the manifold ethical challenges of care digitalization is available for the first time in the German-speaking world. The support of KL Krems for the conference volume underlines their commitment to interdisciplinary fields with high relevance for health policy.

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